Ashley Chloé Tan Uy September 30, 2016

CPC

This is a case of LM, a newborn male, born preterm to a preeclamptic 34 year old G1P0 mother,
delivered via forceps who developed a subgaleal hematoma, subsequently admitted to the
neonatal ICU and eventually succumbed to death.

The problems of the patient include:

1. Nosocomial sepsis. Late-onset sepsis occurs at more than 7 days of life and is acquired from
the caregiving environment. An umbilical catheter was inserted to the patient for 2 weeks.
Patient is premature, which makes him more vulnerable to catheter related blood stream
infections since his immune system has not fully matured. Patient is also
immunocompromised and persistently grew positive cultures for Candida spp. even with anti-
fungal medications.

2. Candida endocarditis. The patient developed murmurs not resolving or improving even with
blood transfusions. Although congenital cardiac anomalies cannot be ruled out, the likelihood
of the patient acquiring endocarditis is high since the patient is positive for Candida albicans
which is the most common cause of fungal endocarditis.

3. Subgaleal hemorrhage. Patient was born via forceps extraction and developed subgaleal
hematoma. Patient could have experienced subgaleal hemorrhage, which is most common in
babies born via forceps or vacuum extraction. Because blood spreads through a large tissue
plane in subgaleal hemorrhage, blood loss might have already been massive.

4. Aspiration pneumonia. On the 6th ICU day, patient developed aspiration pneumonia. Patient
has an OGT inserted. Gastroesophageal reflux is common in babies most especially in
preterms since their organs are not yet fully matured. The presence of an OGT increases the
likelihood of reflux due to the persistence of a pathway. This could have led to the aspiration
pneumonia of the patient.